Some Republicans, including Governor Matt Bevin of Kentucky, believe these results are necessary to fix what they see as a broken Medicaid system. Governor Bevin stated, “The piper has to get paid at some point.” Other Republicans, such as Governor Doug Ducey of Arizona said that none of the governors “want to see any citizen have the rug pulled out from underneath them” and that the governors would work hard to improve healthcare and reform the Medicaid system.

The Affordable Care Act has a provision that permits state governments to launch experimental healthcare reforms so long as certain coverage expansions and consumer protections remain. Vermont’s experiment, which was approved by the Obama administration in October, is notable because it is being enacted in a blue state, despite the experimental plan’s many similarities to Republican proposals.

News Update for February 24, 2017

Draft of Obamacare Replacement Bill Leaked

Politico has obtained a draft of a House Republican repeal bill. The bill would take apart the Obamacare individual mandate, end subsidies based on income for the individual insurance marketplace, roll back Medicaid expansion funding, and give state governments money to help them create high-risk pools for people with pre-existing conditions.

The replacement would fund itself “by limiting tax breaks on generous health plans people get at work.” Read more.

House Republicans Are Trying to Work With Republican Governors on Obamacare Repeal Compromise Bill

The National Governors Association is meeting in Washington for the next couple of days. President Donald Trump will meet with many Republican leaders over the issue of Medicaid funding. Ohio governor John Kasich, a Republican and key supporter of the Medicaid expansion under Obamacare, is a major critic of defunding Medicaid. He will meet with Trump privately over the next few days. House Republicans have reached out to Kasich and Nevada governor Brian Sandoval, another Republican supportive of Medicaid expansion. Many Republican officials throughout the country are in the same boat as Kasich and Sandoval: having to choose between the party line, or whether or not to defund a program that hundreds of thousands rely on in their own states.

Former House Speaker John Boehner, at a healthcare conference in Orlando on Thursday, stated that a complete repeal and replace of the Affordable Care Act is “not what’s going to happen.” Boehner, who left politics in 2015 after being pressured out by conservatives in his own party, said that he “started laughing” when Republicans said that they were going to quickly repeal and replace the law. Boehner believes that the Republicans will probably “fix the flaws and put a more conservative box around it,” but the essential framework of the law would probably stay intact. He added, “In the 25 years that I served in the United States Congress, Republicans never, ever, one time agreed on what a healthcare proposal should look like. Not once.”

The pools under Speaker Ryan’s plan would be run by state governments and be partially financed by the federal government. Ryan’s “A Better Way” plan would give out $2.5 billion a year for the next decade in order to help fund high-risk pools. High-risk pools operated in 35 states before the Affordable Care Act, but their effectiveness was inconsistent. Before the ACA’s reforms took effect, $5 billion was set aside by the federal government to set up a “temporary national high-risk pool program.” According to Kathleen Sebelius, a former Secretary of Health and Human Services under President Obama, the pools “ran out of money because the costs were far more expensive than anyone could have, would have predicted just given the fact that there’s some really sick folks out there.” Many conservative health policy experts also agree that the plan and its financing are unworkable. “The needed amount is more like $16 billion [a year],” says Dean Clancy, a health policy consultant who worked in the George W. Bush administration.

Congressional Republicans Not Expecting Trump to Offer His Own Plans for Obamacare Repeal

In January, President Donald Trump said that he and his allies in Congress would be “filing a plan” for Obamacare’s repeal and replacement as soon as Tom Price was confirmed as Secretary of Health and Human Services. Now, indications from the executive branch and the House suggest that Trump will go for a hands-off approach. Congressional Republicans are expecting Trump to not involve himself in the crafting of the legislation. They are, however, expecting him to provide his public endorsement of later proposed bills in order to get them passed.

GOP Looking to Cut Out Parts of Obamacare’s 10 Essential Benefits

Hoping to cut costs, some Republicans are suggesting a roundabout solution to cutting or weakening Obamacare’s 10 essential health benefits. Because the benefits are explicitly laid out in the Affordable Care Act, the law would have to be changed outright in order to get rid of them. This is unlikely to happen immediately as it would be highly improbable for Republicans to obtain the 60 Senate votes needed to enact this scenario. Instead, Republicans could change regulations that federal officials wrote to enact the law. This would, in effect, weaken or eliminate the enforcement of the 10 essential health benefits. Read this NPR article to learn more.

Small Businesses Are Worried Congress Will Continue Ignoring Their Insurance Complaints in Obamacare Repeal

Employer-based health insurance is the largest source of coverage in America, and “more than 56 million Americans work for small businesses,” which make up to 90 percent of the country’s employers. The percentage of employers who offer employer-based health benefits has been falling over the last 20 years, led mostly by small businesses who struggle to afford the coverage.

Barbara Otto, the director of Health and Disability Advocates in Chicago, an organization that advocates for increased access to healthcare, said “Small business must have a seat at the table. They were not central to the first round of healthcare reform.” She believes that if the new administration can center small employers as a cornerstone for any new healthcare reform laws, the administration will be able to provide an environment for financial growth and more efficient health insurance coverage.

News Update for February 22, 2017

Protests and Contentious Town Halls Continue for Republican Lawmakers Seeking to Repeal Obamacare

Only 17 percent of Americans polled (1,201 likely voters in 12 Senate battleground states) believe the ACA should be repealed immediately. 34 percent believe it should be repealed only when a replacement is available.

Only 33 percent of Republicans believe the law should be repealed immediately. 56 percent believe in repeal and replace.

If repeal passes, 69 percent of respondents believe that the replacement should be enacted immediately. 10 percent believe repeal should be enacted within 6 months. Another 10 percent believe it should take place within a year.

66 percent of all voters say they would oppose Democrats who would oppose all replacement plans.

Republican Senators Offer Two Proposals for ACA Risk Corridors Program

The Affordable Care Act’s risk corridors program was designed to attract more comprehensive insurance plans onto the ACA exchanges. As these new plans would be covering more benefits, the ACA established the risk corridors program to help keep these plans affordable to consumers while at the same time economically sustainable for the insurance companies. The risk corridors program used cash from exchange plan companies that did well between 2014 to 2016 to help those that did not do as well in the same years. Many Republicans oppose the risk corridors program. They believe that it is a bailout for health insurance companies. The program, according to the Department of Health and Human Services, owes insurance companies about $8 billion for 2014 and 2015. “Risk corridors program managers have collected enough cash to pay only 15 percent of the 2014 program obligations. Managers have not made any payments for 2015.”

Senator Marco Rubio (R-FL) has proposed a bill that would prevent the HHS from making any payments to these plans.

Senator Bill Cassidy (R-LA) has proposed a bill that “would create an optional grant program for states, using the cash that otherwise would be spent on each state’s Affordable Care Act coverage expansion programs.” This bill would allow state governments more autonomy over their approaches to risk corridors programs.

California Senate Introduces Single-Payer Healthcare Bill

State Senator Ricardo Lara (D-Bell Gardens) has introduced a single-payer healthcare bill in the California State Senate. The bill is a preliminary step and, if passed, would officially designate that it would be the “intent of the [State] Legislature” to create a “comprehensive, single-payer health care program.” Experts agree that, while the plan might appeal to many Californians worried about the status of the Affordable Care Act, the disruption that a single-payer system might cause could prove to be its downfall. No specifics were included in the legislation as Lara has, self-admittedly, “not yet figured out the financing” because it is “still early in the legislative process.” Lara was an instrumental figure in last May’s passage of state legislation, which resulted in coverage for 170,000 undocumented immigrant children.